<%@page import="com.gxwz.medical.domain.Reimburse"%>
<%@ page language="java" import="java.util.*" pageEncoding="utf-8"%>
<%@ include file="/common/base.jsp"%>
<%
 String id=request.getParameter("id");
 Reimburse model =new Reimburse(id);
%>
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<html>
<head>
<base href="<%=basePath%>">
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport"
	content="width=device-width, initial-scale=1.0, maximum-scale=1.0, user-scalable=no" />
<meta name="renderer" content="webkit">
<link rel="stylesheet" type="text/css" href="css/styles.css">
<link rel="stylesheet" type="text/css" href="css/admin.css">

<script type="text/javascript" src="js/jquery-1.4.4.min.js"></script>
<script type="text/javascript" src="js/admin.js"></script>
<script type="text/javascript">
	$(document).ready(function() {
		//重新绑定表单提交
		$("#add_btn").bind("click", function() {
			$('form').submit();
		});
	});
</script>

</head>

<body>

	<div class="panel admin-panel">
		<div class="panel-head" id="add">
			<strong><span class="icon-pencil-square-o"></span>修改慢病报销信息</strong>
		</div>
		<div class="body-content">
			<form id="form-add" method="post" class="form-x"
				action="<%=path%>/system/ReimburseServlet?m=edit">
				
				<div class="form-group">
						<div class="label">
							<label>身份证号：</label>
						</div>
						<div class="field">
							<input type="text" id="cardID" name="cardID" value="<%=model.getCardID()%>" class="input w50"   readonly="readonly"/>
							<div class="tips"></div>
						</div>
					</div>
					<div class="form-group">
					<div class="label">
						<label>年度：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50" value="<%=model.getRunyear() %>" id="runyear" name="runyear"
							data-validate="required:请输入年度" />
						<div class="tips"></div>
					</div>
				</div>
				<div class="form-group">
					<div class="label">
						<label>姓名：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50" value="<%=model.getPersname() %>" id="persname" name="persname"
							data-validate="required:请输入姓名" />
						<div class="tips"></div>
					</div>
				</div>
				<div class="form-group">
					<div class="label">
						<label>花费金额：</label>
					</div>
					<div class="field">
						<input type="text" class="input w50" value="<%=model.getPay() %>" name="pay"
							data-validate="required:请输入花费金额" />
						<div class="tips"></div>
					</div>
				</div>
					<div class="form-group">
						<div class="label">
							<label>报销金额：</label>
						</div>
						<div class="field">
							<input type="text" id="paysum" name="paysum" value="<%=model.getPaysum() %>" class="input w50"/>
							<div class="tips"></div>
						</div>
					</div>
				  <div class="form-group">
					<div class="label">
						<label>状态：</label>
					</div>
					<div class="field">
						<select id="status" class="input w50" name="status">
							<option value="1">审核</option>
							<option value="2">未审核</option>
						</select>
						<div class="tips"></div>
					</div>
				</div>
					
				<div class="form-group">
					<div class="label">
						<label></label>
					</div>
					<div class="field">
						<button id="add_btn" class="button bg-main icon-check-square-o"
							type="button">提交</button>
					</div>
				</div>
			</form>
		</div>
	</div>

</body>
</html>